tbuckley/cabot-search huggingface dataset:
A new model of cancer survivorship: Feasibility and findings of a survivorship-based primary care clinic led by a medical oncologist.
Authors: Ilana Yurkiewicz, Natasha Steele
Journal: Journal of Clinical Oncology (2023)

e24043 Background: Since the Institute of Medicine published “From Cancer Patient to Cancer Survivor: Lost in Transition,” there has been widespread recognition of the role of primary care in providing long-term care for cancer survivors. However, many gaps remain as patients transition from oncology to primary care. We report on the findings of an innovative practice model in which a medical oncologist opened a primary care clinic to address survivorship-specific needs and ongoing primary care in one place. Methods: The clinic was housed in the primary care division of a large academic medical center. The physician is board certified in internal medicine, oncology, and hematology. Data were collected from when the clinic opened November 1, 2021 through January 31, 2023 via electronic chart review. Results: A total of 209 patients established care. Seventy-four percent were women, with a mean age 54, age range 19 to 89, and 24% adolescents and young adults aged 39 or younger. The most common cancer was breast (44%), followed by leukemia (12%) and lymphoma (10%). Thirty-two patients (15%) had undergone an allogeneic or autologous bone marrow transplant (BMT). Thirty-three patients (16%) had a hereditary cancer syndrome, including 11 with a BRCA mutation and 10 with a TP53 mutation. A majority (74%) were post treatment; 22% had active disease; and 3% were “previvors” with a genetic syndrome without a cancer diagnosis. Twenty-seven (13%) had more than one cancer. Most referrals came from medical oncology (36%), followed by self-referrals (29%) and hematology or BMT (11%). Most (74%) returned for at least one follow-up visit. Long-term and late effects were addressed in 87% and at least one other primary care problem was managed in 96%. These included cardiovascular risk (92%, with a new cardiovascular medication started in 31 patients), mental health (76%), bone health (47%), sexual health (22%), and fertility (19%). Secondary cancer screening was addressed in 93%, and four secondary cancers were diagnosed. Surveillance for the primary cancer was addressed in 86%, and seven recurrences were diagnosed. Conclusions: Given a growing need to care for cancer survivors and known challenges in the oncology to primary care pipeline, new models of comprehensive survivorship care are greatly needed. This study demonstrates the feasibility and high demand for a novel survivorship-based primary care clinic in which both ongoing survivorship needs and routine primary care are managed concurrently.[Table: see text]
Surgical outcomes and patient-reported outcomes of unresectable stage III non-small cell lung cancer patients who underwent PD-1 inhibitor plus chemo as induction therapy.
Authors: Xin Wang, Guixian Liu, Jintao He, Xiang Zhuang
Journal: Journal of Clinical Oncology (2023)

e20570 Background: For locally advanced unresectable NSCLC, studies of PD-1 inhibitor plus chemo as induction therapy and its roles on subsequent surgical resection are still limited. In this study, a consecutive series of unresectable stage III NSCLC patients were collected to investigate the surgical outcome and postoperative symptom changes in locally advanced patients who received adjuvant chemotherapy combined with immunotherapy. Methods: 92 locally advanced NSCLC patients received 2-4 cycles of chemotherapy combined with immunotherapy. Surgical rates, major pathologic remissions(MPR), pathologic complete remissions(PCR), postoperative complications, and immune-related adverse reactions(irAEs) were assesd. The follow-up of symptoms was performed during treatment and within 3 months postoperatively, and symptom changes were described based on patient-reported outcomes. Results: 26.09% of patients developed irAEs, the most common was skin toxicity, followed by thyroid dysfunction. 71.74% of patients underwent surgical resection. 63.64% (42/66) achieved MPR and PCR, of which 37.87% (25/66) were PCR. Most of these patients have clinical symptoms at the time of presentation, mainly cough (90%), and after treatment, cough is significantly reduced compared with before treatment. After treatment, the cough was significantly reduced compared with before treatment , nausea and vomiting , loss of appetite , dry mouth , and diarrhea were increased or aggravated. The most common symptoms on the first day after operation included pain (90%), shortness of breath (62.5%), fatigue (45%), cough (42.5%), and dry mouth (37.5%). On the third day after surgery, the incidence and severity of each symptom changed significantly, pain and dry mouth decreased significantly compared with before, cough, shortness of breath, and fatigue worsened and the incidence increased. Pain remains the most severe symptom in the early postoperative period, with the most severe on the first day after operation and then reduced, returning to preoperative levels 1.5 months after surgery. Cough was the main symptom at the time of presentation, which was significantly reduced after preoperative treatment, and the incidence and severity of postoperative cough increased significantly compared with preoperative treatment and returned to the preoperative level within 1 week after surgery. Dyspnea lasts long after surgery. Two weeks after surgery, shortness of breath (dyspnea) becomes the most obvious symptom. Conclusions: Preoperative chemotherapy combined with immunotherapy provides more opportunities for radical resection in locally advanced NSCLC patients. The most common postoperative symptoms are pain, dyspnea, cough, and fatigue; dyspnea is the symptom that affects patients the most and lasts the longest after surgery.
The human connection: Oncologist characteristics that facilitate therapeutic bonding among Latino patients with advanced cancer.
Authors: Ana Isabel Tergas, Holly Gwen Prigerson, Frank J. Penedo, Paul K. Maciejewski
Journal: Journal of Clinical Oncology (2023)

e18676 Background: Therapeutic alliances (TA) are bonds between patients and their oncologists characterized by mutual caring, trust, understanding, and respect. They lay the foundation for the provision of high-quality cancer care. We here relate oncologist characteristics to TA in Latino vs. non-Latino advanced cancer patients. Results will inform the development of an intervention to train oncologists in how to develop a strong TA with their Latino patients. Methods: The study population included non-Latino oncologists (n = 41) and their Latino (n = 67) and non-Latino white (n = 90) patients with advanced cancers who participated in Coping with Cancer III, a multi-site prospective cohort study designed to examine Latino/non-Latino disparities in advance care planning and end-of-life cancer care, conducted at U.S. medical centers from 2015-2019. Oncologist characteristics included age, sex, race, institution type, Spanish language proficiency and practice style behaviors (e.g., “familismo”— embracing dedication, commitment, and loyalty to family), addressing patients by their first name, and personal disclosure (e.g., “personalismo”), among others. The average score of 6 items from The Human Connection scale was used to assess the patients’ TA with their oncologists. Hierarchical linear modeling (HLM) was used to evaluate the effects of oncologist characteristics on TA in the full patient sample and stratified by patient ethnicity. Results: Of the 157 patients, 67 (42.7%) were Latino; most were female (n = 92, 58.6%) and &lt; 65 years old (n = 95, 60.5%). Most oncologists were male (n = 24, 58.5%), non-Latino? white (n = 25, 61%), and ≥ 40 years (n = 25, 61%). There were no significant associations between patient age, sex, Medicaid recipient status, education level, marital status, and geographic region with TA. An adjusted HLM in the full sample showed that Latino ethnicity was associated with significantly lower TA (b = −0.16, p = 0.037). In an adjusted HLM for TA stratified by ethnicity, oncologist preference to address patients by their first names (b = 0.34, p = 0.001) and a “familismo” practice style (b = 0.46, p = 0.001) were positively associated with TA among Latino patients. In contrast, “familismo” had no impact on TA for the non-Latino white patients. Conclusions: In this study, Latino patients with advanced cancer had a worse therapeutic alliance with their oncologists compared to non-Latino patients. Cultural differences between Latino and non-Latino white patients may be leveraged in an intervention designed to improve the therapeutic bonding and patient-clinician relationship between oncologists and their Latino patients with advanced cancer, thus potentially mitigating cancer care disparities in this important, often underserved, patient population.
Survival in patients with cancer of unknown primary site (CUP): Mayo Clinic experience.
Authors: Riham Suleiman, Mayra Duran, Sandra Algarin Perneth, Ricardo Loor Torres, Cristian Soto Jacome, Jennifer Gile, Rondell P. Graham, Jose Caetano Villasboas, Roberto Antonio Leon-Ferre, Stephan Thome, Thorvardur Ragnar Halfdanarson, Harry E Fuentes Bayne
Journal: Journal of Clinical Oncology (2023)

e18802 Background: CUP is a rare cancer with an incidence of 7–12 cases per 100,000/year. CUP is defined as metastatic cancer with no identifiable primary tumor despite comprehensive evaluation. Despite its heterogeneous clinicopathological presentation, the treatment of CUP has primarily been with platinum-based combination chemotherapies but results are poor and survival is short. Here, we describe survival outcomes in real-world dataset of patients with CUP seen at a tertiary referral center. Methods: Retrospective study of patients treated at Mayo Clinic, Rochester MN, from 2010 to 2021. Survival probabilities were estimated with the Kaplan-Meier method. We used Cox proportional hazard regression with forward modeling to explore the association between each variable and death. Overall survival (OS) analysis was conducted in the entire cohort, and it was stratified by histological subtype. For the hypothesis test, we considered p &lt; 0.05 to be statistically significant; all tests were two-sided. All data were analyzed by the SPSS version 22.0 software (SPSS, Chicago, IL, United States). Results: From a total of 214 patients, 198 patients were included in the survival analysis. The patients were predominantly white (87%), female (50.2%), with a mean age of 63 (SD: 13) without history of smoking (51%). The predominant histology was adenocarcinoma (30%), followed by neuroendocrine neoplasms (NEN) (27%), carcinoma NOS (25%), squamous cell carcinoma (SCC) (10%) and non-classifiable tumors (7%). The median follow-up time was 23 months, and medial OS was 23 months in the entire cohort. OS by histology was as follows: 51 months for NEN, 34 months for SCC, 18 months for carcinomas NOS and 11 months for adenocarcinomas (p &lt; 0.001) (fig.1). Similar OS trends were observed when we restricted the analysis to poorly differentiated tumors. The 3- and 5-year cumulative survival by histology were as follows: 7% and 0% for adenocarcinoma, 25% and 8% for carcinoma NOS, 39% and 17% for SCC, and 56% and 22% for NEN. In Cox regression models we did not identify any prognostic factors among patients with adenocarcinoma. Conclusions: Patients with adenocarcinoma of unknown primary possess a considerable challenge and the OS is short. CUP of other histologies have higher OS. This study highlights the need of accurate tumor identification and better treatment, perhaps as a multiomics therapeutic approach.
Safety and efficacy of standard of care (SOC) ciltacabtagene autoleucel (Cilta-cel) for relapsed/refractory multiple myeloma (RRMM).
Authors: Doris K. Hansen, Krina K. Patel, Lauren C. Peres, Mehmet H. Kocoglu, Leyla Shune, Gary Simmons, Christopher J. Ferreri, Shebli Atrash, Ricardo Daniel Parrondo, Saurabh Chhabra, Patrick Costello, Shonali Midha, Melissa Alsina, Peter M. Voorhees, Myo Htut, Douglas W. Sborov, Jack Khouri, Murali Janakiram, Yi Lin, Surbhi Sidana
Journal: Journal of Clinical Oncology (2023)

8012 Background: Cilta-cel was FDA approved in 2022 for the treatment of RRMM. We evaluated the outcomes of patients treated with intended SOC cilta-cel. Methods: 12 US academic medical centers contributed data to this retrospective study. As of 12/31/2022, 177 patients were leukapheresed and 139 received cilta-cel. Results: The table describes the study population compared to the CARTITUDE-1 trial. More patients in our study had extramedullary disease (EMD, 35%) and high-risk cytogenetics (41%). 55% of the patients would not have met eligibility criteria for CARTITUDE-1. Common reasons for ineligibility were cytopenias (19%), prior BCMA therapy (14%), organ dysfunction (12%), oligosecretory disease (13%), and plasma cell leukemia (8%). 83% of the patients received bridging chemotherapy (overall response rate, ORR: 28%). Lymphodepletion included fludarabine (Flu) + cyclophosphamide (Cy): 81%, bendamustine: 11%, Cy: 4%, and cladribine + Cy: 4%. Median CAR-T cells infused were 0.6 million/kg (range: 0.1-0.9), and 19% of patients were treated on an expanded access protocol (EAP). Median follow-up was 2.3 months (range: 0-8). Cytokine release syndrome (CRS) was seen in 81% (≥ grade 3: 7%) and immune effector cell-associated neurotoxicity syndrome (ICANS) in 22% (≥ grade 3: 8%) of patients. Tocilizumab, steroids, and anakinra were used in 61%, 44%, and 10% of patients, respectively. Delayed neurotoxicity (NT) was seen in 9% (cranial nerve palsy: 8, Parkinsonism: 2, others: 3). Grade ≥ 3 cytopenias at day ≥ 30 were seen in 75% of patients. Infections were seen in 32% of patients. Day 30 (N=115) and best response rates (N=118) were: ≥ partial response (PR), 75/80%; ≥ very good PR, 44/62%; and ≥ complete response (CR), 26/40%, respectively. In the non-EAP FluCy population (N=88), best ORR/≥CR were 89/49%. 17 patients died by data cut-off, 4 due to disease progression and 13 (9%) due to non-relapse mortality (NRM) (grade 5 CRS: 3, infection: 6, CRS/infection: 1, grade 5 ICANS: 1, delayed NT: 2). Conclusions: Patients treated with intended SOC cilta-cel had a favorable ORR (80%) despite a larger proportion of patients having high-risk features relative to trial patients and limited follow-up. Response rates were higher in patients receiving conforming products with FluCy conditioning (89%). Delayed NT and NRM were seen in 9% of patients. Results will be updated with continued follow-up. D.K.H., K.K.P, M.J., Y.L. &amp; S.S. contributed equally. [Table: see text]
Long-term remission and survival in patients with relapsed or refractory multiple myeloma after treatment of LCAR-B38M CAR-T: At least 5-year follow-up in LEGEND-2.
Authors: Jian-Qing Mi, Wan-Hong Zhao, Li-Juan Chen, Wei-Jun Fu, Bai-Yan Wang, Jie Xu, Jie Liu, Shi-Wei Jin, Han Zhu, Juan Du, Hua Jiang, Huabin Sun, Yehui Jia, Xiao-Hu Fan, Jian-Yong Li, Jian Hou, Zhu Chen, Wang-Gang Zhang, Ai-Li He, Sai-Juan Chen
Journal: Journal of Clinical Oncology (2023)

8010 Background: LCAR-B38M CAR-T cells express a structurally differentiated CAR construct containing a 4-1BB costimulatory domain and 2 BCMA-targeting single-domain antibodies designed to confer avidity. LEGEND-2 was a first-in-human phase 1 study of LCAR-B38M conducted in China, which showed encouraging efficacy and manageable safety in 74 patients (pts) with RRMM. The US phase 1b/2 CARTITUDE-1 and Chinese phase 2 CARTIFAN-1 trials of ciltacabtagene autoleucel, which expresses the same CAR as LCAR-B38M, confirmed the efficacy observed in LEGEND-2. Here, we present ≥5-y FU data from LEGEND-2, the longest FU for any BCMA-targeted CAR-T cell therapy study. Methods: Study design was previously published. Pts underwent lymphodepletion with cyclophosphamide (cy) 300 mg/m 2 (n=66) or cy 250 mg/m 2 plus fludarabine 25 mg/m 2 (n=8) prior to receiving LCAR-B38M at a median dose of 0.51 × 10 6 (range, 0.07-2.10 × 10 6 ) CAR-positive T cells/kg in a single (n=9) or 3 split (n=65) infusions. Results: Pts were enrolled from 30 Mar 2016 to 26 Nov 2017. As of 30 Nov 2022, median FU was 65.4 mo (range, 0.4-78.8). 74 pts had received LCAR-B38M (median age, 54.5 y; 60.8% male; median [range] 3 [1-9] prior lines of therapy [LOT]; 44.6% ISS stage I; 28.4% ISS stage III; 29.7% with extramedullary disease [EMD]; 35.7% cytogenetic high risk). No new CAR-T cell-related toxicities were reported in the analysis. ORR (87.8%), CR rate (73.0%), MRD-negative CR rate (67.6%), median DOR (23 mo), and median PFS (18 mo) were mature and the same as previously reported; median OS was previously not reached. At 65.4-mo median FU, median OS was 55.8 mo, with 33 (44.6%) pts alive and 13 (17.6%) still disease-free. Compared with pts with progressive disease (PD) or who died, pts without PD were more likely to have baseline ECOG performance status (PS) 0, IgG type MM, ISS stage I MM, numerically shorter time from diagnosis, fewer prior LOT, no light chain MM, and no EMD (Table). Conclusions: At ≥5-y FU in LEGEND-2, median OS was 55.8 mo and 18% of pts with RRMM were disease-free, raising the possibility of a cure in this heavily pretreated pt population. Our data suggest that pts who are less heavily pretreated or have good functional status may experience greater benefit, potentially being cured, from LCAR-B38M CAR-T cell therapy. Clinical trial information: NCT03090659 . [Table: see text]
Characterization of URST1 as a prognostic marker and therapeutic target for lung cancer.
Authors: Atsushi Takano, Yohei Miyagi, Yataro Daigo
Journal: Journal of Clinical Oncology (2023)

e21000 Background: The improved understanding of cancer-specific oncoproteins could lead to the development of novel biomarkers or therapeutic targets for lung cancers. Methods: We screened oncoproteins as follows: i) Identification of up-regulated genes in lung cancers by cDNA microarray, ii) Validation of clinicopathologic importance of their gene product by tissue microarray, iii) Examination of the growth of cancer cells after transfection of their siRNA or expression vector, iv) Screening of their signal pathways. Results: We identified up-regulated in solid tumor 1 (URST1) as a candidate. Immunohistochemical staining of URST1 showed that URST1 expression was observed in 231 (64.5%) of 358 non-small cell lung cancers (NSCLC) and 11 (84.6%) of 13 small cell lung cancers. High level of URST1 expression was associated with poor prognosis for NSCLC patients ( P = 0.0003). Multivariate analysis confirmed that strong URST1 expression was an independent prognostic factor for NSCLC patients that had undergone radical surgery. Knockdown of URST1expression by siRNAs against URST1 significantly suppressed the growth of lung cancer cells, and also inhibited the cell invasive ability. Treatment of lung cancer cells with small molecule inhibitor against URST1 suppressed the cell growth partly through G2/M arrest and cell death. In contrast, enforced expression of URST1 significantly promoted lung cancer cell growth. Microarray analysis coupled with siRNAs for URST1 suggested various URST1 related oncogenic pathways in lung cancer cells. Conclusions: URST1 could play an essential role in malignant potential of lung cancer and it might be useful as a prognostic biomarker and therapeutic target molecule for lung cancer.
Comparing survival and clinical characteristics of patients with non-small cell lung cancer who received immune checkpoint inhibitor therapy less than and more than 2 years.
Authors: Brandon Edward Rose, Kyle Edwards, Samuel A. Kareff, Leana Ramos, Nora El-Abbar, Gilberto Lopes, Estelamari Rodriguez
Journal: Journal of Clinical Oncology (2023)

e21214 Background: Immune checkpoint inhibitors (ICIs) have revolutionized the management of non-small cell lung cancer (NSCLC). The current standard of care based on ICI trial design is to discontinue ICI treatment after 2 years, disease progression, or intolerance. The disease progression patterns and survival of patients treated with ICIs beyond 2 years have not been well described in real-world clinical settings. Methods: We retrospectively analyzed 689 patients with advanced NSCLC who received ICI treatment at the University of Miami between June 2004 and February 2020. Patients who survived ≥ 2 years after starting ICI were defined as long-term survivors (LTS) and were divided into two treatment groups: ICI &lt; 2 years or ≥ 2 years. The primary outcome measured was overall survival (OS). The secondary outcomes were demographic, clinical, and pathologic characteristics. Results: A total of 689 patients with advanced NSCLC were administered immunotherapy. Amongst this group, 186 (27%) were designated as LTS, 53 (28%) were treated with ICI ≥ 2 years, and 133 (72%) were treated &lt; 2 years. LTS who were treated for ≥ 2 years had a median OS of 77.4 months compared to 46.2 months for LTS who were treated for less than 2 years (p = 0.0045). The 3-year OS for the ≥ 2 year cohort was 85.9%, compared to 70.8% for the &lt; 2 year cohort. The characteristics of the &lt; 2 year and ≥ 2 year cohort are described in detail in Table 1. There were no statistically significant differences in median age, gender, race, ethnicity, tobacco use, histology, PD-L1 status, or BMI. Conclusions: In this real-world analysis, prolonged ICI therapy provided a long-term benefit with a 15.1% increase 3-year OS in LTS. Patients in both groups had similar demographic characteristics. PD-L1 expression was increased in the &gt; 2 year group. Larger prospective trials are needed to reveal the potential benefits and toxicities of increased ICI treatment length in patients with advanced NSCLC. [Table: see text]